Healthcare Provider Details

I. General information

NPI: 1073532537
Provider Name (Legal Business Name): EMILY C. LICHTENBERG M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8402 HARCOURT RD STE 324
INDIANAPOLIS IN
46260-2052
US

IV. Provider business mailing address

8402 HARCOURT RD STE 324
INDIANAPOLIS IN
46260-2052
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-7475
  • Fax: 317-583-2436
Mailing address:
  • Phone: 317-338-7475
  • Fax: 317-583-2436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: